Surgical treatment approaches and reimbursement costs of surgical site infections post hip arthroplasty in Australia : a retrospective analysis

BACKGROUND: The treatment for deep surgical site infection (SSI) following primary total hip arthroplasty (THA) varies internationally and it is at present unclear which treatment approaches are used in Australia. The aim of this study is to identify current treatment approaches in Queensland, Australia, show success rates and quantify the costs of different treatments. METHODS: Data for patients undergoing primary THA and treatment for infection between January 2006 and December 2009 in Queensland hospitals were extracted from routinely used hospital databases. Records were linked with pathology information to confirm positive organisms. Diagnosis and treatment of infection was determined using ICD-10-AM and ACHI codes, respectively. Treatment costs were estimated based on AR-DRG cost accounting codes assigned to each patient hospital episode. RESULTS: A total of n=114 patients with deep surgical site infection were identified. The majority of patients (74%) were first treated with debridement, antibiotics and implant retention (DAIR), which was successful in eradicating the infection in 60.3% of patients with an average cost of $13,187. The remaining first treatments were 1-stage revision, successful in 89.7% with average costs of $27,006, and 2-stage revisions, successful in 92.9% of cases with average costs of $42,772. Multiple treatments following 'failed DAIR' cost on average $29,560, for failed 1-stage revision were $24,357, for failed 2-stage revision were $70,381 and were $23,805 for excision arthroplasty. CONCLUSIONS: As treatment costs in Australia are high primary prevention is important and the economics of competing treatment choices should be carefully considered. These currently vary greatly across international settings.

Equity in estate litigation : setting aside inter vivos transactions post mortem on the grounds of undue influence and unconscionable bargains

Where the value of an estate of a deceased person has been diminished by intervivos transfers of property, equitable doctrines provide powerful tools for practitioners advising those who are seeking to claim benefits under wills (or an intestacy) and those seeking further and better provision from the deceased estate.

Pragmatism and precision : psychology in the service of civil litigation

While forensic psychology is commonly associated with the criminal and family law domains, its ambit to offer skills and knowledge at the legal interface also makes it particularly suited to the civil law domain. At this time, civil law is arguably the least represented legislative area in terms of psychological research and professional commentary. However, it is also a broad area, with its very breadth providing scope for research consideration, as urged by Greene. The purposes of this article are (1) to review the broad role of the psychologist in the conduct of civil litigation matters in Australia, (2) to assist the novice to the area by indicating a non-exhaustive list of potentially ambiguous terms and concepts common to the conduct of professional practice, and; (3) to highlight, as an example, one area of practice not only where legal direction demands professional pragmatism but also where opportunity arises for psychological research to vitally address a major social issue.

Open for Inspection? Julstar Pty Ltd v Lynch Morgan Lawyers [2012] QDC 272

In Julstar Pty Ltd v Lynch Morgan Lawyers [2012] QDC 272 Dorney QC DCJ considered whether an applicant for an assessment of all or part of their costs under s 335 of the Legal Profession Act 2007 (Qld) (LPA) must provide grounds on which they dispute the amount of the costs charged or their liability to pay them. His Honour also made an order for inspection of the solicitor’s file, despite a claimed lien for unpaid fees.

Lifecycle costs of ultracapacitors in electric vehicle applications

The pulse power characteristics of ultracapacitors appear well suited to electric vehicle applications, where they may supply the peak power more efficiently than the battery, and can prevent excessive over sizing of the battery pack due to peak power demands. Operation of ultracapacitors in battery electric vehicles is examined for possible improvements in system efficiency, vehicle driving range, battery pack lifetime, and potential reductions in system lifecycle cost. The lifecycle operation of these ultracapacitors is simulated using custom-built, dynamic simulation code constructed in Matlab. Despite apparent gains in system efficiency and driving range, the results strongly suggest that the inclusion of ultracapacitors in the electric vehicle does not make sense from a lifecycle cost perspective. Furthermore, a comparison with results from earlier work shows that this outcome is highly dependant upon the efficiency and cost of the battery under consideration. However, it is likely that the lifecycle cost benefits of ultracapacitors in these electric vehicles would be, at most, marginal and do not justify the additional capital costs and system complexity that would be incurred in the vehicle

Simulated lifecycle costs of ultracapacitors in battery electric vehicles

The pulse power characteristics of ultracapacitors appear well suited to electric vehicle applications, where they may supply the peak power more efficiently than the battery, and can prevent excessive over sizing of the battery pack due to peak power demands. Operation of ultracapacitors in battery electric vehicles (BEVs) is examined for possible improvements in system efficiency, vehicle driving range, battery pack lifetime, and potential reductions in system lifecycle cost. The lifecycle operation of these ultracapacitors is simulated using a custom-built, dynamic simulation code constructed in Matlab. Despite apparent gains in system efficiency and driving range, the lifecycle cost benefits as simulated appear to be marginal, and are heavily influenced by the incremental cost of power components. However, additional factors are identified which, in reality, will drive ultracapacitors towards viability in electric vehicle applications.

The health outcomes and costs of people attending an interdisciplinary chronic disease service in regional Australia : protocol for a longitudinal cohort investigation

Background Rates of chronic disease are escalating around the world. To date health service evaluations have focused on interventions for single chronic diseases. However, evaluations of the effectiveness of new intervention strategies that target single chronic diseases as well as multimorbidity are required, particularly in areas outside major metropolitan centres where access to services, such as specialist care, is difficult and where the retention and recruitment of health professionals affects service provision. Methods This study is a longitudinal investigation with a baseline and three follow-up assessments comparing the health and health costs of people with chronic disease before and after intervention at a chronic disease clinic, in regional Australia. The clinic is led by students under the supervision of health professionals. The study will provide preliminary evidence regarding the effectiveness of the intervention, and evaluate the influence of a range of factors on the health outcomes and costs of the patients attending the clinic. Patients will be evaluated at baseline (intake to the service), and at 3-, 6-, and 12-months after intake to the service. Health will be measured using the SF-36 and health costs will be measured using government and medical record sources. The intervention involves students and health professionals from multiple professions working together to treat patients with programs that include education and exercise therapy programs for back pain, and Healthy Lifestyle programs; as well as individual consultations involving single professions. Discussion Understanding the effect of a range of factors on the health state and health costs of people attending an interdisciplinary clinic will inform health service provision for this clinical group and will determine which factors need to be controlled for in future observational studies. Preliminary evidence regarding changes in health and health costs associated with the intervention will be a platform for future clinical trials of intervention effectiveness. The results will be of interest to teams investigating new chronic disease programs particularly for people with multimorbidity, and in areas outside major metropolitan centres.

Data requirements of hedonic models in determining the impact of infrastructure charges on new housing costs

The use of hedonic models to estimate the effects of various factors on house prices is well established. This paper examines a number of international hedonic house price models that seek to quantify the effect of infrastructure charges on new house prices. This work is an important factor in the housing affordability debate, with many governments in high growth areas having user-pays infrastructure charging policies operating in tandem with housing affordability objectives, with no empirical evidence on the impact of one on the other. This research finds there is little consistency between existing models and the data sets utilised. Specification appears dependent upon data availability rather than sound theoretical grounding. This may lead to a lack of external validity with model specification dependent upon data availability rather than sound theoretical grounding.

Offer to settle in an originating application : is it an offer under the UCPR?

Sheryl Jackson looks at the decision of Justice McMeekin in Northbound Property Group Pty Ltd v Carosi (No.2) [2013] QSC 189.

Metabolomic analysis of siderophore cheater mutants reveals metabolic costs of expression in uropathogenic escherichia coli

Bacterial siderophores are a group of chemically diverse, virulence-associated secondary metabolites whose expression exerts metabolic costs. A combined bacterial genetic and metabolomic approach revealed differential metabolomic impacts associated with biosynthesis of different siderophore structural families. Despite myriad genetic differences, the metabolome of a cheater mutant lacking a single set of siderophore biosynthetic genes more closely approximate that of a nonpathogenic K12 strain than its isogenic, uropathogen parent strain. Siderophore types associated with greater metabolomic perturbations are less common among human isolates, suggesting that metabolic costs influence success in a human population. Although different siderophores share a common iron acquisition function, our analysis shows how a metabolomic approach can distinguish their relative metabolic impacts in E.coli.

Wrongful birth assessment of damages : judgment pending

Damages issues regarding the costs of raising the child argued in a case currently before the NSW Supreme Court - Waller v James litigation pre-dated the Health Care Liability Act 2001 and the Civil Liability Act 2002.

'Too high in human terms' : the costs of high security imprisonment. Review of Imprisoning Resistance by Bree Carlton and Intractable by Bernie Matthews.

The article discusses the issues of resistance; that is resistance by prisoners to the various manifestations of power operating in high security prisons, as well as that of attempted shifts in the regime from physical to psychological control. Other topics highlighted include legitimacy and 'official discourse', mourning and the construction of 'ungrievable lives' and the importance of finding a way out of the cycle of violence, which high security regimes perpetuate.

From "Secondary Punishment" to "Supermax" : the human costs of high-security regimes in Australia

“Supermax” prisons, conceived by the United States in the early 1980s, are typically reserved for convicted political criminals such as terrorists and spies and for other inmates who are considered to pose a serious ongoing threat to the wider community, to the security of correctional institutions, or to the safety of other inmates. Prisoners are usually restricted to their cells for up to twenty-three hours a day and typically have minimal contact with other inmates and correctional staff. Not only does the Federal Bureau of Prisons operate one of these facilities, but almost every state has either a supermax wing or stand-alone supermax prison. The Globalization of Supermax Prisons examines why nine advanced industrialized countries have adopted the supermax prototype, paying particular attention to the economic, social, and political processes that have affected each state. Featuring essays that look at the U.S.-run prisons of Abu Ghraib and Guantanemo, this collection seeks to determine if the American model is the basis for the establishment of these facilities and considers such issues as the support or opposition to the building of a supermax and why opposition efforts failed; the allegation of human rights abuses within these prisons; and the extent to which the decision to build a supermax was influenced by developments in the United States. Additionally, contributors address such domestic matters as the role of crime rates, media sensationalism, and terrorism in each country’s decision to build a supermax prison.

Ghost hunting with lollies, chess and Lego : appreciating the ‘messy’ complexity (and costs) of doing difficult research in education

This paper contributes to conversations about the funding and quality of education research. The paper proceeds in two parts. Part I sets the context by presenting an historical analysis of funding allocations made to Education research through the ARC’s Discovery projects scheme between the years 2002 and 2014, and compares these trends to allocations made to another field within the Social, Behavioural and Economic Sciences assessment panel: Psychology and Cognitive Science. Part II highlights the consequences of underfunding education research by presenting evidence from an Australian Research Council Discovery project that is tracking the experiences of disaffected students who are referred to behaviour schools. The re-scoping decisions that became necessary and the incidental costs that accrue from complications that occur in the field are illustrated and discussed through vignettes of research with “ghosts” who don’t like school but who do like lollies, chess and Lego.